Expectations of physiotherapy treatment of patients with persistent pain have been shown to influence treatment outcome and patient satisfaction, yet this is mostly explored and described in retrospective. The aim of the study was to explore and describe the expectations people with persistent pain have prior to physiotherapy treatment. Ten participants with persistent musculoskeletal pain from the back, neck, or shoulders were included in the study. Data were collected by interviews using a semi-structured interview guide and were analyzed with qualitative content analysis. The analysis resulted in one main category: “The multifaceted picture of expectations” and four categories: 1) Standing in the doorway: curious and uncertain; 2) Looking for respect, confirmation and knowledge; 3) Expecting treatment, regular training, and follow up; and 4) Having dreams, being realistic, or feeling resigned. The main category and the categories describe a multifaceted picture of the participants’ expectations, gradually developed and eventually encompassing several aspects: good dialog and communication, the need to be confirmed as individuals, and getting an explanation for the pain. The results also show that the participants expected tailored training with frequent follow-ups and their expectations of outcome ranged from hope of the best possible results to realistic or resigned regarding pain relief and activity levels.

The aim of this study was to explore and describe the physiotherapy treatment experiences of persons with persistent musculoskeletal pain. Eleven participants with persistent musculoskeletal pain in the back, neck, or shoulders were included in the study. Data was collected via semi-structured interviews and were analysed with qualitative content analysis. The analysis resulted in the theme "Towards acceptance and management of pain", comprising four sub-themes: 1) Establishing and maintaining a therapeutic alliance; 2) Being active, taking initiative and facing challenges; 3) Appreciating guidance, incentive and having a sounding board; and 4) Acquired knowledge and new body awareness change behaviours. The theme and sub-themes describe how the participants used increased knowledge, awareness, movements and exercises learned from the physiotherapy treatment to develop strategies for managing pain and the process of acceptance. A trusting relationship and continual dialogue with the physiotherapist was considered to be important. The participants were actively involved in the process as exercises, activities and other treatment modalities were individualized. This was rewarding but also challenging and required effort on their part. The physiotherapist's initiatives and actions were an important incentive and means of support.

Objective: An increasing number of adults with ADHD face problems with everyday activities, and occupational therapists play an important role regarding interventions for this particular group. However, there is a knowledge gap within occupational therapy regarding how adults with ADHD experience engagement in everyday activities. The aim of this study was to understand the experiences of engagement in, and describe how adults with ADHD performed everyday activities. Methods: Twelve people with ADHD between the ages of 21 and 38 were interviewed using a semi-structured interview guide. Data were analysed based on a qualitative content analysis. Results: The results showed how engagement in and performance of everyday activities depended on inspiration, facilitating support, and feelings of togetherness with other people. Conclusions: These results show how adults with ADHD can find strategies to become more independent in their performance of everyday activities. Furthermore, this study suggests how occupational therapists can increase opportunities for adults with ADHD to engage in different activities, make choices, and find meaning in everyday activities.

Det övergripande syftet i denna avhandling var att få en fördjupad kunskap om och förståelse för upplevelsen av den sociala miljöns betydelse för delaktighet i dagliga aktiviteter hos kvinnor med ryggmärgsskada och deras män samt om upplevelsen förändrades över tid. För att besvara syftet valdes en kvalitativ forskningsdesign till de fyra studierna. Totalt kom 13 kvinnor, mellan 25 och 65 år, med en ryggmärgsskada att delta i studie I- III. I studie IV, deltog fyra män som var gifta/sambo med någon av kvinnorna i studie I-II. All data samlades in genom intervjuer och minnesanteckningar fördes parallellt. Under intervjuerna ställdes frågor i ett tidsperspektiv för att fånga förändringsprocessen. Olika kvalitativa metoder har använts för analys till studierna. I resultatet från studie I framkom olika förändringar i kvinnornas sociala nätverk. Kvinnorna var i behov av både emotionellt och praktiskt stöd för att vara delaktiga i dagliga aktiviteter. Det var en ny erfarenhet som det tog tid att anpassa sig till. Resultatet visade även att kvinnorna efter skadan kom att ta större ansvar för relationer i nätverket och hur dessa kom att utvecklas. Kvinnorna kom också att förändra sina egna vanor för att bibehålla tidigare roller och relationer med personer i deras nätverk. I studie II framkom att emotionellt och praktiskt stöd skapade upplevelser av trygghet och gemenskap som ledde till att kvinnorna blev motiverade till att delta i dagliga aktiviteter. I ett tidsperspektiv blev det också tydligt att kvinnorna strax efter skadan var i behov av att få stöd, medan de en längre tid efter skadan upplevde det betydelsefullt att stödet var ömsesidigt. Studie III visade på en komplexitet i kvinnornas berättelser om hur de blev bemötta i dagliga aktiviteter och en skillnad mellan hur personer agerade i förhållande till dem och hur kvinnorna själva agerade över tid. Det kan ses som en förklaring till att kvinnornas agerande förändrades från att vara passiva till aktiva i möten med personer i deras nätverk. Studie IV resulterade i en berättelse som inkluderar männens upplevelser och agerande. I berättelsen framkommer att männen gick igenom en dynamisk förändringsprocess och att de tog emot och gav både emotionellt och praktiskt stöd för att hantera deras förändrade livssituation. Sammanfattningsvis visar resultatet att kvinnor med en ryggmärgsskada upplevde påtagliga förändringar i deras sociala nätverk efter skadan, vilket på ett flertal sätt påverkade deras möjligheter till att vara delaktiga i dagliga aktiviteter. För att anpassa sig till denna nya livssituation kom kvinnorna, men även deras män, att successivt utveckla olika strategier i förhållande till deras nätverk. Resultatet visar även på vikten av att inom rehabiliteringen identifiera personer i det sociala nätverket som klienter utvecklat sin relation till och samverkar med i vardagen och integrera dem i rehabiliteringen. Vidare, dessa resultat bygger på kvinnorna och männens berättelser från strax före skadan fram till nutid och genom dessa berättelser kunde den komplexa förändringsprocess de gick igenom fångas

Objective: Women with a spinal cord injury (SCI) often require support from others to perform their everyday activities. The aim was to describe OTs' experiences of how social support from the network influences or could influence the rehabilitation of women with SCIs. Methods: Four occupational therapists, specialized in rehabilitation of persons with SCIs, narrated 11 separate stories relating to women with an SCI. Five themes were identified: “Assisting the women to identify new ways to perform activities”, “Giving support to the women by re-establishing relationships on their behalf”, “Enabling the women to find solutions to problems that have an impact on everyday activities”, “Enabling the women to learn what it is like to live with an SCI from first-hand accounts”, and “Assisting the women to set goals in anticipation of life outside the clinic”. Results and conclusions: The results indicate that professionals within rehabilitation need to be aware of and actively create and strengthen natural social networks during the complex and demanding rehabilitation process. Furthermore, they ought to use their capacity as professionals to ensure that support is provided and to reduce negative interactions within the injured person's network, given that social support, social integration, and negative interactions have the potential to influence health and well-being. Read More: http://informahealthcare.com/eprint/PVNrjad5BhRFXpjUbMnp/full

Purpose. To gain an understanding of how women with spinal cord injury (SCI) experienced human encounters in occupations and how these influenced their participation. Method. The data were collected through two or three in-depth interviews with 13 women (age 25 - 61 years) with SCI. Data analysis was carried out by using a paradigmatic analysis of narrative data, followed by an interpretation based on a narrative theory. Results. The results showed a complexity where the women's experiences and acting in human encounters changed over time. In these human encounters the women struggled with conflicts, supported other persons that were insecure and revaluated their apprehension about persons in their social network. These multidimensional human encounters thereby enabled them to regain participation in occupations. Conclusions. This shows that human encounters are important for persons with disabilities so they can restructure their occupational identity and their needs for participation in occupations. The study also showed that the use of narratives as a tool within rehabilitation could lead to an increased understanding of the subjective changes that occur over time for a person with a disability

The aim of this study was to gain an understanding of how men living with women with spinal cord injury (SCI) experienced and acted when they were giving and taking social support to and from their wives and other persons in their social network. Another aim was to give some possible explanations of the complex process of change that they went through. Data were collected through in-depth interviews with four men and field notes. To describe the men's subjective experiences and the process of change, a narrative approach inspired by Polkinghorne was used. The analyses resulted in one story that included the four men's experiences and action. The story showed that when the men went through a process of change, they used and needed both emotional and practical support to handle their new life situation. Furthermore, the men's experiences and action against social support changed over time. This indicated that, through narratives from spouses, professionals within rehabilitation could understand the process of change they went through after their partner's sudden injury, and support them to find strategies to handle their changed life situation. To give some possible explanations for the men's experiences and action during the process of change, the findings are discussed in relation to theories concerning adaptation and coping

In this study, a qualitative perspective of how 13 women (aged 25 to 61 years) with spinal cord injury perceive the importance of social support for their participation in occupation is presented. The data were collected through repeated in-depth interviews and field notes, and the analysis used a grounded theory approach. The women needed both emotional and practical support, which was important in a time perspective and motivated them to participate in occupation. The women needed to receive support soon after the injury, but after a period of time they needed to give and receive support in a reciprocal fashion. Social support is therefore an effective rehabilitation strategy that can motivate people with disabilities to participate in meaningful occupation. The importance of social support for a person's motivation and ability to participate in occupation expands our knowledge of the relationship between individuals, their social environment, and occupation.

Projektets övergripande syfte  Syftet med detta projekt var att få en fördjupad kunskap om och förståelse för upplevelsen av den sociala miljöns betydelse för delaktighet i dagliga aktiviteter hos kvinnor med en ryggmärgsskada och deras män samt om upplevelsen förändrades över tid.   Kort beskrivning av projektet  Projektet fokuserar på betydelsen av det sociala nätverket och dess relation till aktivitet och hälsa inom rehabilitering och arbetsterapi. Utgångspunkten var att det behövs en ökad kunskap om hur personer med funktionshinder upplever betydelsen av socialt stöd från det sociala nätverket eftersom en framgångsrik rehabilitering förutsätter att en person med funktionshinder upplever socialt stöd från det sociala nätverket. Målgruppen för att belysa detta har i projektet varit kvinnor som drabbats av en ryggmärgsskada, då de ofta får omfattande funktionshinder med förändrade vanor vid aktivitetsutförande samt förändrade relationer i deras sociala nätverk. Vidare för att kunskap om kvinnor med ryggmärgsskada är begränsad. I projektet har även män som var sammanboende med kvinnor med en ryggmärgsskada ingått. Metodologiskt har projektet en kvalitativ inriktning där deltagarna intervjuats om deras upplevelser av det sociala nätverkets betydelse för delaktighet i vardagen från strax före skadan fram till idag. Resultaten visar att över tid utvecklades ett förändrat samspel mellan kvinnorna och deras sociala nätverk som influerade deras delaktighet i dagliga aktiviteter. Resultatet påvisade även betydelsen av berättelser för att fånga dynamiken och komplexiteten i den förändringsprocess som både kvinnorna och männen som var sammanboende med dem gick igenom. Vidare hur klient-centrerad praxis som inkluderar även anhöriga kan utveckla en djupare förståelse för dynamiken och samspelet mellan personen, aktiviteter och socialt samspel.  Detta forskningsprojekt kan därför tillföra arbetsterapeuter, men även annan personal inom rehabilitering, en ökad kunskap om den sociala miljöns betydelse för utförandet av aktiviteter i det dagliga livet. 

Purpose. The aim was to describe and offer an explanation for how one woman viewed her everyday life after a spinal cord injury (SCI). Method. Data were collected by conducting three interviews with one woman with a SCI. Open-ended questions were used with the intention of capturing the woman's own story. The narrative approach inspired by Polkinghorne was used to describe the woman's experiences of her everyday life after the SCI. Results. The analysis revealed that, events influenced her everyday life after a SCI and these events influenced her identity, habits and participation in activities. Further, how she has gone from a state of hopelessness in the early days to a reconstructed identity, associated with a new insight during the 2 years after the accident through a complex and dynamic process of change. In our interpretation we have attempted to provide an explanation of why this outcome came about. Conclusions. When using narratives, professionals within health-care could focus on the individual instead of the diagnosis or disability. Further, according to a client-centred perspective it is important to attain the client's experiences and knowledge to gain a more complete picture in order to obtain a profound understanding of the client.

PURPOSE: To describe how women with a spinal cord injury (SCI) perceived changes in the social network, and how these changes affected their ability to participate in occupation. METHOD: Thirteen women, aged 25 to 61 years, with a SCI were interviewed twice. The interviews focused on their ability to participate in occupation, their relations with individuals within the social network, and changes in the social network following the SCI. The analysis was carried out using qualitative content analysis. RESULTS: The women described an emotional need for social support after the SCI to participate in occupation. This was a new experience that required time to adapt to. The women also described a need for practical social support from the social network members to manage meaningful occupation. After the SCI, the women had developed new habits through close cooperation with members in the social network. The women felt that they had become more responsible for the development of their relations. Many relations had improved after the SCI, while some had decreased. The women had also developed new relations with other persons with disabilities. CONCLUSIONS: The women perceived substantial changes in the social network following the SCI, which in several ways affected their ability to participate in occupation. To adapt to their new life situation, the women gradually developed different strategies. The results point out the need to identify persons in the social network that women with SCI develop relations with, and integrate them in the rehabilitation process.

The majority of individuals on long-term sick leave experience negative effects in their lives associated with limitations on their participation, decreased income, and feelings of guilt. The aim was to describe the experiences that women on long-term sick leave have of participation in occupation. Unstructured interviews were used for the data collection, which involved eight women; a grounded theory approach was used. The results showed that the women's long-term sick leave changed their roles, daily habits, and routines, and their participation in occupations was negatively influenced. Their occupational performance also diminished, thereby having a negative influence on their social relationships. However, over time they came to find different strategies that contributed to a feeling of occupational competence and thence they started to rebuild their occupational identity. Through this began the process of occupational adaptation, which resulted in an increased experience of participating in occupation. As a conclusion, it should be noted that occupational therapy interventions should be directed at women on long-term sick leave at an early stage in the rehabilitation process to address the adaptation of their roles, habits, routines, and social environment

Social participation is positively associated with older adults’ health. Health-care services, therefore, need to empower older adults to adapt to the social changes that accompany aging. This systematic review, with a metasynthesis of qualitative studies, aimed to describe and develop an understanding of home-dwelling older adults’ (65 yrs+) experiences of using strategies to maintain and foster their social participation. The main search was performed in March 2022 using the PubMed, CINAHL, PsycINFO, and AMED databases and included peer-reviewed articles published between 2012 and 2022. A total of 35 full-text articles from 15 different countries were included and assessed for quality by the assessment tool for qualitative studies provided by the Critical Appraisal Skills Programme (CASP). The metasynthesis resulted in the main theme: strategically creating routines that foster social participation and two main categories: inward-looking strategies for social participation and outward-looking strategies for social participation. Each main category contained three subcategories. The findings suggest that for perceiving social participation, it is important for older adults to create routines with patterns of activities and to be able to engage in these activities. The findings further reflect that older adults use earlier experiences of social participation to facilitate the making of routines. This indicates that health-care interventions supporting older adults’ social participation must be applied early and with a health-promotive focus. Conclusively, researchers need to develop interventions that support older adults in healthy activity patterns by raising awareness of how to use inward-looking and outward-looking strategies to create routines for social participation. The findings further suggest that older adults’ possibilities for social participation could be supported by designing accessible venues that facilitate spontaneous meetings and encourage older adults’ own choices and initiatives for social participation.

Recovery and occupation-centered practices with persons with severe psychiatric disabilities involve many dynamic issues and processes. This study aimed to develop an understanding of how the therapeutic process unfolds in occupational therapy among persons with severe psychiatric disabilities living in sheltered or supported housing. Repeated interviews were conducted with two occupational therapists working in sheltered and supported housing facilities. Narrative analysis was used to analyze their stories. The findings reveal “personalized occupational transformations” describing significant events of interaction establishing therapeutic processes to promote personal agency and social recovery while targeting meaningful activities based on each resident’s wishes

This study aimed to gain understanding of participation in everyday occupations through life stories of persons aging with a traumatic spinal cord injury (SCI). Method: A narrative method was used for data collection and a paradigmatic analysis was used to analyze data. Results: The analysis resulted in three themes that illustrate how the participants acted to participate in everyday occupations, how that changed over time, and some concerns about their future. The first theme illustrates how participants following SCI acted to become agents of their lives and participate in everyday occupations. The second theme illustrates how participants had to prioritize participation in meaningful occupations due to personal and environmental factors. The third theme shows how they had to try new strategies to continue participation in occupations, due to secondary health complications related to aging. Conclusions: This study captures how persons aging with tetraplegia acted to participate in everyday occupations from soon after the injury until several decades later. In addition, their ability to act and participate changed over time. Our findings provide knowledge that can guide clinicians in their work within this complex area of rehabilitation. Besides, it can also guide the work with policy recommendations for healthcare and social service systems.Implications for Rehabilitation

People aging with spinal cord injury (SCI) develop medical problems commonly associated with the aging process at a younger age than the general population. However, research about how the life story changes and how meaning will be experienced in occupations is lacking. The aim was to describe and offer an explanation of how a man experienced meaning in everyday occupations while aging with an SCI. Four narrative interviews were performed over a four-year period, with a man in his fifties, who lived with SCI for 39 years. The narrative analysis generated an overall plot, named "To Work Just Like Anyone Else," and gives a picture of his experiences, thoughts, and reflections about meaning in occupations, from when he became injured to the present, and in relation to his future. His life story is characterized by secondary health complications, and his experiences of negotiating with the aging body and making choices to continue working. Further, how occupational risk factors, e.g., imbalance, alienation, and deprivation, occur as a result of lack of rehabilitation and support from social systems is addressed. Future research should explore how rehabilitation and social systems can support people aging with SCI to experience meaning in everyday occupations and to have balance in everyday life.

Objective: To explore and describe the leisure repertoire of persons with traumatic spinal cord injury (SCI) and how the repertoire is related to interest, performance, and well-being.Design: Cross-sectional study.Setting: A total of 97 persons with traumatic SCI were recruited from the non-profit national organization, RG Active Rehabilitation in Sweden.Outcome measure: Data were collected through a two-part postal survey. The first comprised of questions investigating socio-demographic variables and injury characteristics; the second part included an interest checklist with 20 areas of leisure activities.Results: The participants were mostly interested in, performed, and experienced well-being from social and culture activities and TV/DVD/movies. The areas of leisure activities in which they had most likely experienced changes after the SCI were outdoor activities, exercise, and gardening. Gender, age, and to some extent, time since injury were related to interest, performance, well-being, and changed performance.Conclusions: The results provided an explanation and limited description of a changed leisure repertoire among persons after a traumatic SCI. The study showed that gender, age, and time since injury were more closely related to the choice of leisure activities to include in the leisure repertoire than the level of injury. This knowledge can be of importance when professionals in the field of rehabilitation are planning and implementing interventions concerning leisure activities for persons with SCI.

STUDY DESIGN:

Cross-sectional study.

OBJECTIVES:

To describe participation in activities and explore the relationship with secondary complications among persons aging with a traumatic spinal cord injury (SCI).

SETTING:

A regional SCI outpatient center in Sweden.

METHODS:

Data were collected through a phone survey, which included 10 activities from the instrument PARTS/M-v3 (PARTicipation Survey/Mobility version-3) together with data from the participants' medical records. Cross-tabulation and χ² were used for data analysis.

RESULTS:

In this study, 121 persons matched the inclusion criteria and the final study sample comprised 73 participants (60% response rate): 55 men and 18 women. Mean age was 63.7±9.4 years, and mean time since injury was 36.3±9.2 years. Regardless of duration of SCI, all 73 participated in dressing, bathing and leisure activities. Women reported better health than men. Particularly for those who lived 36-55 years after injury; increasing pain, fatigue, spasticity and decreased muscle strength were negatively affecting participation in activities, especially exercise and active recreation. Additionally, a need to save strength/energy was also a reason for not participating in the activities. Perceived future support and concerns in relation to personal assistance, assistive devices and rehabilitation was also reported.

CONCLUSION:

Increasing secondary health complications and a need to save strength/energy influenced participation in activities. Laws and/or governmental policies regarding personal assistance and assistive devices did not always support participation in activities. Interventions should aim to create a balance among activities in everyday life

Background

Social participation concerns the possibility of engaging in activities in interaction with others or society at large and contributes to the health and well-being of older adults. In contrast, a lack of social participation is associated with loneliness. It is, therefore, important to understand what strategies older adults use to maintain social participation.

Aim

To explore and describe older adults’ experiences of maintaining social participation.

Materials and methods

Nine older adults, aged 69–92 years, participated in interviews that were analysed through qualitative content analysis.

Results

The overall findings reflect how older adults create opportunities for social participation by developing strategies and striving to adapt to changing situations, emphasizing how maintaining social participation is an active process. Preserving social participation requires motivation and an effort to take initiative to cultivate social relations, maintain community bonds, engage in social events and activities and stay connected with society.

Conclusions and significance

These results may extend our understanding of strategies that older adults use, as well as the challenges they face when striving to adapt to new circumstances. This study may have implications for the practice of how to support older adults’ social participation.

Changing demographics with an increased proportion of older adults indicate the need to develop new health-promoting interventions where the potential of digitization is considered. The aim was to explore and create an understanding of how social online meetings are experienced by older adults. Interviews with older adults generated data that were analyzed using a grounded theory approach. The participants were interviewed after participating in a digital health promotion group initiative provided in a municipality context. A core conceptual category and three subcategories reflected an intertwined process of discovering facets of social participation where internal reflections on personal values and needs were nurtured by an external driven process of becoming part of a group in an online context. Occupational therapists and other health and social care professionals need to consider the various facets of social participation when supporting older adults active and healthy aging.

Background: Fostering social participation for active and healthy ageing among older adults is an urgent issue in a changing society that requires new approaches from occupational therapists as well as from society at large.

Aim: To explore possibilities to foster social participation for older adults in society from the perspective of stakeholders.

Material and methods: A qualitative design was applied. 18 key informants, engaged in supporting older adults in their organisational roles as either professionals or volunteers, participated in five different focus groups discussions.

Results: The results involved two overarching themes that reflects different perspectives on key informants’ possibilities to foster social participation for older adults. The first theme describes how they direct their attention towards their roles within the organisations to foster social participation in their own context. The second theme describes the broader societal perspectives that they address to establish a common ground for collaboration and knowledge-sharing among different stakeholders.

Conclusions: The findings emphasise how addressing common challenges and developing collaboration are essential to foster older adults’ social participation. It is therefore necessary to involve policy-makers and decision-makers. Occupational therapists and researchers should consider the value of occupational justice to drive collective and social approaches.

Background: This paper is in line with the on-going discussion of a theoretical re-orientation towards acknowledging the socio-cultural dimensions of occupation.

Aim: To define enacted togetherness as a concept and share our understandings of how this concept can add to the understanding of occupation as socio-culturally situated.

Method and material: The concept enacted togetherness emerged from empirical findings of a larger research project with older adults living with late-life depression. Informed by a transactional understanding of occupation and a narrative approach, the concept emerged as a contextually situated process holding qualities and potential as a source of meaning-making.

Findings: Enacted togetherness as described herein has a clear association to occupation in terms of doing activities together. We reflect on enacted togetherness as a process of meaning-making, connecting people and places through unfolding stories; as an arena where togetherness and belonging can be created; and as a space for interpretation, providing opportunities to negotiate issues of meaning that can lead to possibilities for change.

Conclusion: The concept of enacted togetherness can contribute to the ongoing discussion of a theoretical reorientation towards understanding socio-cultural dimensions of occupation.

Significance: Enacted togetherness is a concept that can contribute to occupational therapy and occupational science as it adds to an understanding of the qualities and potentials inherent in engagement in occupations with others.

Objective: This article explores and describes how the Internet was experienced as a tool for togetherness in everyday occupations among older adults. Methods: Discussions with 12 older adults, divided into three focus groups, generated data that were analysed using a grounded theory approach. Six women and six men between 67 and 79 years of age were purposively selected and recruited from a retirement organization in northern Sweden. Results: Findings reflect how online contexts generated new possibilities for togetherness in everyday occupations and created a sense of belonging with others and to society at large. However, togetherness through the Internet was also associated with ambiguity and uncertainty among older adults. The Internet provided opportunities for togetherness that were somehow different from togetherness derived from face-to-face contact, but it was also connected with a fear and a resistance. Conclusions: Findings from this research can extend our understanding of how online contexts have the possibility to promote togetherness in everyday occupations and what it means to be part of such a context among older adults. In light of these findings, the need is highlighted to consider the Internet as a tool for older adults to be socially engaged with the potential to reduce loneliness and isolation.

Josephsson S, Alsaker S, Isaksson G, Lindström M, Aldrich R, Nyman A. Rethinking occupation in research and clinical practice: Joining people, places and meaning. Discussion Forum at Conference: SSO: USA; Society for the Study of occupation: USA, October 2012.

Recent developments in occupational science conceptualize occupation and its relation to place in terms of dynamic processes rather than components and structures. It could be phrased as a move from what occupation is to how it works. There has been a simultaneous trend of challenging the view of occupation as residing within individuals. Combining these two developments, occupation may now be conceptualized as emerging from situations that encompass transactions of person, culture, environment, and more. The aim of this panel is to reflect and discuss the consequence of this shift for occupation-based research and practice. Based on the included papers we will argue for the need of a less individual and static conceptualization of occupation and we will consider possible ways on how such shift of conceptualization can be achieved. The panel will include five papers: Sissel Alsaker will present research on enacted meaning using a narrative– in – action approach among women in Norway with chronic rheumatic condition. She will argue for how narrative – in – action might be an analytic resource to access occupation as ongoing processes rather than in terms of static characteristics. Maria Lindström will discuss based on her intervention research on persons with persistent mental illness, showing how the lack of a social conceptualization of occupation can decrease the visibility of certain research results. Gunilla Isaksson will base her reasoning on a narrative study on how men living with women with spinal cord injury experienced and acted in the complex process of change they went through after the women’s injury and how support was acted among them and their social network. Rebecca Aldrich will discuss the relationship of process and occupation’s social nature, as exemplified by data on routines from ethnographic research on North Carolinian discouraged workers. Finally, Anneli Nyman will demonstrate drawing from an ongoing study on social processes of participation among elderly women with depression and using narrative analysis on interview data, how enacted togetherness can be a resource for occupation-based practice with persons under such conditions. References: Aldrich, R. & Dickie, V. (In press): “It’s hard to plan your day when you have no money”: Discouraged workers’ occupational possibilities and the need to reconceptualize routine. Work, A Journal of Prevention, Assessment, and Rehabilitation. Alsaker, S. & Josephsson, S. (2010) Occupation and meaning: Narrative in everyday activities of women with chronic rheumatic conditions. OTJR – Occupation, Participation and Health, 30(2), 58-67). Lindström, M (2011) Promoting agency among people with severe psychiatric disability: occupation-oriented interventions in home and community settings. (Doctoral dissertation). Umeå University Key words: occupation; social; process; unit of analyses Discussion: -Why is it important for occupational science research to rethink how we conceptualize occupation? -What can a contextual, process-oriented and multifaceted conceptualization of occupation mean in occupational science research as well as clinical practice? -What are the consequences of such conceptualizations for how we measure and assess outcomes in research as well as in practice?

This article explores how agency is enacted in everyday occupations with others and evolves over time. Agency is a complex concept that is closely linked to human occupation. By using a transactional perspective and a narrative approach, our ambition was to explore agency beyond individual acts or responsibilities. To achieve this, we used a story of an older woman in the context of being widowed and living with late-life depression. Data were generated over time using interviews and by taking part in the participant's everyday occupations. Narrative analysis was used to create a contextualized in-depth story. The findings show how resources embedded in enacted stories can challenge one's view of oneself as a victim and create possibilities to be an agent, thereby illustrating how agency becomes enacted in the context of acting together in everyday occupations. In light of these findings, we reflect on how a transactional perspective can contribute to exploring the concept of agency as contextually situated and embedded in occupations. Further, we reflect on how the transactional dimensions of everyday occupations can be explored through a narrative approach.

In this article, we explored how five elderly persons with depression engaged in everyday activities with others, over time, and how this was related to their experience of meaning. Repeated interviews and participant observations generated data that was analysed using a narrative approach. Analysis identified togetherness as an acted relation, “enacted togetherness”, emphasising how the act of doing everyday activities with someone created togetherness and belonging, and being part of an enacted togetherness seemed to be a way for the participants to negotiate and construct meaning. Opportunities for doing things together with someone were closely associated to the place where the participants lived. Furthermore, engagement in activities together with others created hope and expectations of future acting. Findings from this research can extend our understanding of how participating in everyday activities is experienced as a social process including change over time, presenting the perspective of elderly people themselves. In light of these findings, we highlight the need to consider how opportunities to become part of an enacted togetherness can be created. Also, we aspire to contribute to the debate on how to understand the complexity related to social aspects of ageing and add to the emerging understanding of everyday activities as transactional, incorporating people and the environment in a dynamic process that goes beyond the individual.

Aim: The aim of this study was to explore and enhance the understanding of how togetherness in everyday occupations is experienced and discussed among older adults. Method: Focus-group discussions generated the data and a total of 12 participants, including six women and six men, divided into three groups, participated in this study. Analysis was performed using a grounded theory approach. Results: The findings reflect how togetherness in everyday occupations can be comprehended as multifold transactional processes, emphasizing how an acted belonging was a situated experience connecting people and places through unfolding stories. The findings suggest that the process of meaning-making in ongoing life was closely associated with togetherness and was negotiated with others through shared culture and experiences. Togetherness meant being part of something in which the persons involved were contributing to each other in various ways. However, being part of togetherness was complicated, especially when the person’s life situation was challenged in some way. Conclusions: It was apparent from the analysis that togetherness could not be taken for granted. Rather, the findings reflect how togetherness was created and maintained through an ongoing process of nurturing established relationships as well as creating something new around occupations with others.

This article describes the process of using PAR and discusses the strengths and challenges of adopting it as a methodology. With a pilot project “the rehabilitation journey” as a showcase, we share experiences of how we co-created knowledge and illustrate the actions taken and participants’ involvement in the process. This pilot project aimed to explore how ICT solutions can create new ways to deliver home-based rehabilitation that meet the needs of the organization, rehabilitation professionals, and older persons. Our experience is that using PAR as a research method had several strengths. Our project stemmed from demographic and epidemiological trends in society viewed as a “real life problem” experienced on different levels in the organization of home-based rehabilitation. At the same time, PAR was a challenging research method to use, as it was time-consuming and required the commitment and contribution over time of the different participants involved. There were also specific challenges that had to be considered regarding routines and regulations, as the pilot project was conducted in a health care context. This article aspires to offer methodological guidelines by using a six-step method to illustrate a PAR process. We propose that these guidelines can act as a tool to guide researchers in carrying out PAR.

Background: To promote health and well-being, and to meet the desires of the growing elderly population to age in place, elderly spousal caregivers need adequate support such as respite care services. More knowledge is needed about elderly spousal caregivers’ experiences in relation to participation, which is an aspect of health that remains relatively unexplored for this group.

Aim: To explore and describe how elderly spousal caregivers experience and discuss participation in everyday life when living in shifting contexts due to the use of respite care.

Method: A grounded theory approach was used during data generation and analysis, which involved repeated focus group interviews with 12 spousal caregivers.

Results: Complexity and ambiguity was understood to imbue participation in everyday life. Being in charge of everyday life was challenging for spousal caregivers, and created a need for personal time. Respite care and home care service gave them time, although when interacting with social contexts other issues arose that influenced their own recovery.

Conclusions: A holistic ‘situation centered’ approach that focuses on the elderly couple’s life story and needs might capture a wider perspective and enable adequate support that influences their health, well-being, and participation in everyday life.

Ageing in place is an imminent concern for both older couples and communities. Identifying ways to support ageing in place is required to meet the needs and challenges of older couples and social services systems. Through focus groups with a total of 46 participants and a constant comparative methodology, this study aimed to explore and describe the experiences and reasoning of spousal carers, healthcare professionals, and stakeholders regarding possibilities for older couples to age in place. The findings consisted of one main category, ‘Facilitating ageing in place is a win-win situation with challenges’ and four interrelated categories, ‘Focus on older couples – building relationships and providing adequate services’, ‘Engaged civil society as a source of care and social inclusion,’ ‘Motivated professionals with competence and time,’ and ‘Services working together for a sustainable society,’ that present possibilities and challenges for ageing in place. This study suggests that facilitating ageing in place is possible but involves a complex series of challenges that can be linked to different contexts ranging from individuals and couples to civil society, services provided, organisational systems, and existing resources. All these aspects need to be considered and balanced to achieve a situation that contributes to older couples' possibilities to age in place as well as to a sustainable society.

Aims

The aim is to describe healthcare professionals’ perspectives on how they understand and promote older couples’ participation in everyday life when using residential respite care.

Design and Methods

Eighteen healthcare professionals with varying degrees of competence and from one residential respite care facility participated in four focus group interviews. Data were analysed through qualitative latent content analysis.

Findings

The findings revealed a broad, multifaceted view of participation and ways in which participation in everyday life is promoted by these professionals. Trustworthy relationships between professionals, spousal caregivers and clients were implicated. Promoting participation also necessitated that clients have access to meaningful activities. In addition, participation entailed an environment that supported various needs.

Conclusion

Promoting participation for older couples that are using respite care involves multifaceted perspectives that consider social–relational aspects including both the client and their spouse. Furthermore, attention is needed to the meaning a change of context between home and the respite care facility has on relationships, environments and activities in everyday life. Such an approach could benefit the couples’ shared everyday life situation and in a wider perspective, also influence their health and well‐being when ageing in place together.

The aim of this study was to explore how elderly couples, who are in need of social services in the community, act and reason over time regarding their everyday togetherness. Data were generated through repeated interviews and participant observations with three older couples. A narrative method was used for data generation and analysis. The findings present four parallel narratives illustrating how the couples, over time, strove to continue living their lives in togetherness despite the many challenges that had emerged. These narratives show the complexity and variety of strategies that the couples adopted to handle different situations of everyday life and the couples’ experiences and feelings connected to these situations. The strategies that the couples used resulted, for example, in performing more activities together in another way, using respite care and reorganizing their social interactions. The spousal caregiver had a leading role to manage day-to-day life and to initiate and perform the strategies. Simultaneously, an important reciprocity existed in their relationship that gave meaning to their efforts of sustaining togetherness. These findings give a deeper understanding of the complexity of their situation and of how meaning is created in their everyday life through enacted togetherness. The findings highlight the need for professionals within social services in the community to embrace a couple's whole situation, involving both partners.